Turf toe is defined as a sprain of the ligaments of the great toe joint. This injury is commonly seen in professional and college athletes who play on artificial turf – hence the name “turf toe”. Although it is most commonly seen in football, this injury can occur in any sport.
The great toe joint’s function is an essential for high performance sports. It allows athletes to push off and propel during running or jumping activities. Any compromise in the joint may produce less explosiveness.
The great toe joint consists of the proximal phalanx, the first metatarsal, and the tibial and fibular sesamoid. Several ligaments and muscles contribute to stabilizing the joint. Ligaments on the sides and bottom of the joint (medial and lateral collateral ligaments, and plantar plate ligament) connect the first metatarsal to the proximal phalanx. The sesamoids lie just above the plantar plate, within the substance of a tendon (flexor hallucis brevis). The sesamoids act as a fulcrum at the great toe joint, thereby giving additional strength to the tendon as it flexes the toe. Lastly, several muscles in the foot (flexor halluxis brevis, abductor hallucis brevis, and adductor hallucis brevis) all surround the joint to give further stability in the joint.
In turf toe injuries, the plantar plate is what is often injured. However, the medial and lateral collateral ligaments, as well as the sesamoids, can also be injured.
Mechanism of Turf Toe
A turf toe injury occurs when there is a forceful, severe hyperflexion of the great toe joint. It often occurs when a strong force is placed down on a fixed foot with the ankle pointed downwards and the great toe joint flexed up. The force causes the toe to hyperextend, straining the ligament (plantar plate) on the bottom of the joint.
Artificial turf, when compared to a natural grass surface, has a higher coefficient of friction. This means that the foot is more likely to be fixed to the turf than to grass. This increases the likelihood of a force coming down on a fixed foot during impact and causing the great toe joint to be sprained.
Athletes that wear flexible cleats are more at risk to this injury than athletes who wear a cleat with a rigid or stiff forefoot. A shoe with a flexible forefoot will place more force on the great toe joint during sports, placing it at greater risk to develop this injury.
Presentation of Patients with Turf Toe
After a history is taken of the mechanism of injury, the exam of the great toe joint involves testing for pain in various structures of the great toe joint. These structures include the plantar plate ligament, the collateral ligaments of the joint, and the sesamoid apparatus.
Range of motion is used to test for stability of the joint, mechanical block that may be occurring, or hypermobility of the joint. The exam may be difficult secondary to pain and swelling.
X-rays are useful in identifying any bone injury/fracture that was sustained. Stress x-rays where the joint is stressed in various positions can be useful to evaluate if the ligaments have been compromised. Of particular interest on x-rays would be the sesamoids. An x-ray of the non-injured foot is valuable in comparing the difference between the sesamoids. An injury or shift in the sesamoids is indicative of a more serious injury that may require surgery. MRI can be useful to evaluate the degree of injury to the ligaments as well as evaluate for any cartilage injury that may have occurred to the great toe joint.
Turf Toe Treatment Options
Most turf toe injuries are treated conservatively, with immobilization in a cast or boot, rest, ice, and elevation. Depending on the severity of the injury, gradual range of motion and physical therapy is introduced after 1-3 weeks of immobilization. Shoe modifications or various taping techniques may be used to slowly return the patient to activity.
Surgery is often not needed for these injuries unless there is persistent instability, pain, or weakness. Surgery may also be indicated if there was damage or shift to the sesamoid apparatus, cartilage injury, or traumatic bony deformity from the injury.
Turf toe can cause significant disability depending on the structures that are damaged. It is important to have this injury evaluated and treated by a foot specialist. If not properly treated, patients with turf toe can develop stiffness, arthritis, or weakness in the joint.
For an appointment with a doctor at one of our nine Greater Los Angeles and Southern California locations please call (877) 989-9110 or visit us at www.footankleinstitute.com.
He then went on to complete his surgical reconstruction fellowship with the University Foot and Ankle Institute, one of only a few fellowships recognized by the American College Foot and Ankle Surgeons.
Now playing an integral role at the University Foot and Ankle Institute, Dr. Yau’s treats various sports injuries, including sprains, arthritis and fractures. He also is passionate about helping diabetic patients avoid amputation through correction of deformities and wound healing.
Dr. Yau is available for consultation at our Simi Valley location.
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